Out of Group Permission

[pbaker]

Is there anyone out there who requires a pathologist signature to give compatible out of group products to patients? Our current policy is to have a path approval ANY TIME we give a product that is not ABO/Rh identical. Even if we give an O+ packed cell to a B+ patient or an AB plasma to any patient, we must get path approval. The answer I receive from the pathologist is that we live in a very litigious county and they are afraid of law suits. Please help me get rid of this practice.

[John C. Staley]

That is utter nonsense!!!

Apparently this pathologist has no respect for your education and training. There is likely no way you could change their paranoid leanings on this subject. That being the case, I would make every effort to need to change blood types on any patient after midnight!

The only time we needed to consult with the pathologists was providing Rh pos blood to Rh neg patients and only then if they were wormen of child bearing age.

:disbelief :disbelief :disbelief :disbelief

[khalidm3]

We take permission (Verbal) of our MD if release ABO, incompatible or Rh pos to Rh Negative Platelets.

ABO & Rh compatible mismatch, we just issue and inform him, if he or an other BB physician is around (all products).

More than last 10 years, we never issued Rh + red cells to Rh-

The Blood Bank may initiate a policy, and if required approval of transfusion Committee, to transfuse ABO mismatch compatible products and get approved from the hospital director. All the staff including the pathologist will feel comfortable when they will have a written protocol.

Edited December 29, 2010 by khalidm3

[Malcolm Needs ☆]

That is utter nonsense!!!

Apparently this pathologist has no respect for your education and training. There is likely no way you could change their paranoid leanings on this subject. That being the case, I would make every effort to need to change blood types on any patient after midnight!

The only time we needed to consult with the pathologists was providing Rh pos blood to Rh neg patients and only then if they were wormen of child bearing age.

:disbelief :disbelief :disbelief :disbelief

I agee with entirely John (particularly the bit about after midnight)!

:devilish::devilish:

[KKidd]

It is standard practice here that you give ABO compatible to group B or AB if ABO identical units are not available. We have a comment in our policy stating that we choose ABO identical whole blood ( can't remember the last time that was in stock) or ABO compatible RBC. Our pathologist has reviewed the P&P and signed it. Perhaps you could go this route.

:wave::wave:

[David Saikin]

We need path approval to give Rh+ to Rh=.

[L106]

That is utter nonsense!!!

Apparently this pathologist has no respect for your education and training. There is likely no way you could change their paranoid leanings on this subject. That being the case, I would make every effort to need to change blood types on any patient after midnight!

The only time we needed to consult with the pathologists was providing Rh pos blood to Rh neg patients and only then if they were wormen of child bearing age.

:disbelief :disbelief :disbelief :disbelief

Same here.

[LaraT23]

Good ness NO! why the pathologist would have to sit in the blood bank some days. The only thing at all close that we need path approval on is if we have to tranfuse an RH neg elderly person with RH pos in a crisis.

[tbostock]

I agree; that's ridiculous. You should have a policy for compatibility...for each blood type for a patient we have "first choice", then "alternative compatible types" next to that. Have your pathologist agree and sign the policy. That way he is "approving" each time it happens because it is your policy.

The only thing you should have him approve each time is giving Rh Pos to an Rh Neg patient.

[Malcolm Needs ☆]

I agree entirely Terri; overkill or what?

I would go slightly further though; if the patient is over 60, there is no worry about future (natural) pregnancies, and so, does it really matter if the patient makes an anti-D? I would include them in the policy.

[Dr. Pepper]

You could take the policy a step further out of the lab and make "Acceptable alternative blood groups" part of your hospital's transfusion policies. Maybe that would sit better with your pathologist. Another advantage to this is that it would serve as a resource (assuming they could find it) for Nervous Nellie nurses giving AB FFP to a B etc.

[tbostock]

Dr. Pepper: great idea

Malcolm: we still get pathology approval even if over 60 years old; we still don't want to give them an anti-D if they have 30 years more to go of cancer treatments, surgeries, ruptured aneurysms....haha...seriously, though, we try not to give Rh Pos to anyone who is Rh Neg unless it is absolutely necessary (trauma, etc).

[Malcolm Needs ☆]

Oh, sorry Terri; I agree. I didn't put that very well. What I really meant was, you give ABO and Rh type if you can, but if you can't, and the patient is over 60, then do you really have to get physicians' permission.

[pbaker]

Thank you for this suggestion, Dr. P. I really like it. That is the other reason for the extra step, to assure the nurses that we know what we are doing

[Eagle Eye]

we need pathologist approval for Rh switch (Rh pos to Rh neg patient) , only for RBC regardless of age. For platelet, if patient is not child bearing age, we have it in our policy that we do not need pathologist approval.

I agree with Malcom regarding older patient...but we make decision at higher level on Rh switch based on the need and inventory. We do not want to switch patient Rh type if we have enough Rh Neg or if we could get more from blood center or if we have short dated Rh Negs....etc...so basically lots of thinking before we switch patient Rh type for RBC.

I totally agree with John, start calling your pathologist every night (2-3 times) and wait to see...he or she will change the policy.

This is like there is no respect to our knowledge,, we went to school and we know what is ABO compatible and what is not??? Isn't it???

[John Hansen]

I know it can seem insulting when they call you asking if a unit is compatible, but at least it is some reassurance that they are actually looking at the unit's and patient's blood types before transfusion. Not all in blood bank do a good job, and even the ones that know what they are doing can make mistakes.

[L106]

I know it can seem insulting when they call you asking if a unit is compatible, but at least it is some reassurance that they are actually looking at the unit's and patient's blood types before transfusion. Not all in blood bank do a good job, and even the ones that know what they are doing can make mistakes.

John, I totally agree with you. Whenever a nurse calls the Blood Bank about something she's not sure about or is uncomfortable about, I always praise her for checking.

For example, if a nurse calls and questions that we have issued a B Negative Red Cell Unit to her patient that is AB Negative, I reassure her that "such a match is OK and safe, but thank you for checking. You know, the next time you call about something that doesn't seem right to you, you might be catching an important error that could harm the patient (or cost me my job!)"

Donna

[MAGNUM]

I agree with John, if I had to call a path each and every time I needed to provide blood of a type other than the patients own, I would be constantly on the phone especially in the case of AB patients. I do not keep AB packed cells in stock since they are few and far between.

In fact recently we had a AAA and after all was said and done and I reported to my Path, his comment was how many times did you change his Rh? He respects my knowledge and trusts that what we do is the correct process.

[Eagle Eye]

I also agree with John & L106...when nurses calls to question that patient is O pos and we issued A plasma...Is it OK to transfuse? That means they are reading and paying attention...which is a good thing..

[AMcCord]

I also agree with John & L106...when nurses calls to question that patient is O pos and we issued A plasma...Is it OK to transfuse? That means they are reading and paying attention...which is a good thing..

We do a quick orientation to lab for all new nursing hires. When I talk to them about basis Blood Bank issues, I always encourage them to ask questions then and at any point in the future. I tell them that if they don't know the answer, it's not a dumb question. It's a good way to build a relationship with nursing service. I can't tell you how many times I've been able to deal with problems more easily because one of the nurses involved has had a positive contact with me in the past. Better for the patients any way you look at it and better for my stress level, too.

[khalidm3]

We do a quick orientation to lab for all new nursing hires. When I talk to them about basis Blood Bank issues, I always encourage them to ask questions then and at any point in the future. I tell them that if they don't know the answer, it's not a dumb question. It's a good way to build a relationship with nursing service. I can't tell you how many times I've been able to deal with problems more easily because one of the nurses involved has had a positive contact with me in the past. Better for the patients any way you look at it and better for my stress level, too.

Yes, best and prompt way

[Mary**]

:ohmygod:

I also agree with John & L106...when nurses calls to question that patient is O pos and we issued A plasma...Is it OK to transfuse? That means they are reading and paying attention...which is a good thing..

I agree with John and L106 as well. I love it when they question something. They have even caught some of our mistakes but I am sorry to say that they had to do this. Thank God they were looking closely.

[pbaker]

Thank you for all your good ideas. When the same information was presented to the pathologist with different wording, he accepted. As of 2/1/11 we will no longer need permission to do what blood bankers are trained to do.

[bduff]

woooohooo!!! Congrats to you!!!

[Likewine99]

We do not require Pathologist approval when we transfuse out of group.

On the rare occasion that we give Rh pos blood to an Rh neg pt we do notify the Pathologist but in that scenario it is usually after a massively bleeding situation.